Provider Demographics
NPI:1295733111
Name:SEISER, SHANNON (CNM)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:SEISER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3621 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1633
Mailing Address - Country:US
Mailing Address - Phone:734-647-5299
Mailing Address - Fax:
Practice Address - Street 1:1500 E MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-5000
Practice Address - Country:US
Practice Address - Phone:734-936-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH08000176B00000X
OHNM-08000367A00000X
MI4704223716367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH05225OtherPARAMOUNT
OH344428256055OtherCARESOURCE
OH000000356143OtherANTHEM
OH344428256OtherFRONTPATH
OH344428256OtherBEECHSTREET
OH2538294Medicaid
MI4693047Medicaid
MI4693038Medicaid
OH344428256OtherBEECHSTREET
75931Medicare PIN